What Is Amniotic Fluid Embolism?

Amniotic fluid embolism (AFE) is a rare but serious complication that can develop during or immediately after childbirth.

This type of embolism happens when amniotic fluid (the liquid that surrounds a fetus during pregnancy) enters a person's bloodstream during labor or shortly after delivery. This causes the body to produce an overwhelming allergic-like reaction to the foreign material.

An amniotic fluid embolism can cause potentially life-threatening breathing and heart issues, as well as uncontrolled bleeding. It is an often fatal emergency that requires immediate medical care for both the pregnant person and the baby.

Amniotic Fluid Embolism Signs

Verywell / Jessica Olah

Signs

The signs and symptoms of amniotic fluid embolism can sometimes overlap with other childbirth complications, making it difficult to recognize.

Amniotic fluid embolism can occur in both vaginal and cesarean (C-section) births. It usually happens in labor, during C-section, or within a half-hour of delivery.

Signs of an amniotic fluid embolism can include:

  • Sudden shortness of breath
  • Skin discoloration
  • Rapid or abnormal heart rate
  • Sudden low blood pressure
  • Severe agitation or anxiety
  • Confusion
  • Chills
  • Vomiting or nausea
  • Signs that the baby is in distress (such as heart rate changes or decreased movement in the womb)

These initial signs are often quickly followed by more serious symptoms, such as:

Causes

The exact causes of amniotic fluid embolism are still unknown because it is so rare.

Researchers do know that when the amniotic fluid (or fetal material like cells or hair) makes its way into the person's bloodstream, it causes an allergic-like reaction that can be fatal. The inflammatory response leads to organ damage, particularly to the lungs and heart.

Experts are not sure why some people's immune systems react so severely to amniotic fluid entering the bloodstream.

One theory is that some people are more prone to allergies, provoking immune-related responses to any contact with a foreign substance in the body. More research is needed to determine the specific causes of amniotic fluid embolism.

Diagnosis

It is hard for doctors to diagnose amniotic fluid embolism because the symptoms are similar to other childbirth-related complications. Additionally, there is no specific test to diagnose the condition, which means that other conditions will need to be ruled out first.

Amniotic fluid embolism must be diagnosed and treated quickly. Since time is limited, your doctor may initiate one or more of the following tests to quickly determine the cause.

  • Blood tests to evaluate any blood clotting
  • Electrocardiogram (ECG or EKG) to monitor heart rate
  • Chest X-ray to detect any fluid around the heart
  • Pulse oximetry to check the amount of oxygen in the blood

Treatment

If your doctor suspects you could have an amniotic fluid embolism, you’ll need immediate emergency treatment to prevent potentially life-threatening complications.

There is currently no standard of care or treatment guidelines for amniotic fluid embolism because it is such a rare condition. The focus of the treatment is to prevent the amniotic embolism from leading to coma or death for the person or their baby.

Depending on the situation, steps that might be taken include:

If amniotic fluid embolism happens before delivering the baby, your doctor will treat you with the goal of safely delivering as soon as possible (which might mean having an emergency C-section) to increase your baby's chances of survival.

After birth, your baby will be taken to the neonatal intensive care unit (NICU) for close observation and monitoring for signs of distress.

Complications

Amniotic fluid embolism can cause serious complications for a pregnant person and their baby. These life-threatening complications can include:

  • Permanent brain damage due to low blood oxygen
  • Multi-organ failure
  • Maternal death 
  • Infant death

People who survive amniotic fluid embolism are likely to experience long-term health issues that range in severity. These complications will likely require treatment in the intensive care unit (ICU) and a long hospital stay to recover.

A baby may have delayed development or limited brain function after experiencing an amniotic fluid embolism.

Possible long-term complications of an amniotic fluid embolism include:

  • Memory loss or other neurological issues
  • Temporary or permanent heart damage
  • Nervous system dysfunction

Risk Factors

Experts do not know for sure why amniotic fluid embolism happens. Research points to a few factors that might be linked to an increased risk of experiencing the condition.

Keep in mind that these risk factors are fairly common. Having one or more does not mean you will experience amniotic fluid embolism. Talk to your doctor if you have any concerns about your risk.

Some of the potential risk factors for amniotic fluid embolism include:

If you've experienced an amniotic fluid embolism and are considering another pregnancy, experts recommend that you talk to a doctor who specializes in high-risk pregnancies (perinatologist) to go over the risks.

Coping

Experiencing a life-threatening condition during childbirth is frightening. Survivors of amniotic fluid embolism experience lasting medical and emotional effects from the traumatic event.

Your doctor will want to continue monitoring you for any related medical complications throughout your recovery and beyond. Part of your ongoing treatment should be mental health support, which is key to the recovery process.

Support for Grief and Loss

People who survive amniotic fluid embolism may develop depression, mood disorders, post-traumatic stress disorder (PTSD), anxiety, guilt, and isolation. For some people, recovery includes grieving the loss of an infant. One resource is the Amniotic Fluid Embolism Foundation support group forum, which is specific to people who have been through the experience.

Frequently Asked Questions

How common is amniotic fluid embolism?

Amniotic fluid embolism is rare. Estimates suggest that it happens in roughly 1 in 40,000 pregnancies.

What causes amniotic fluid embolism?

Amniotic fluid embolism happens when amniotic fluid (or fetal material like fetal cells, hair, or other debris) enters a pregnant person's bloodstream during childbirth.

Some people's bodies overreact to the foreign material, causing an overwhelming immune response and leading to serious cardiac and respiratory issues.

How do you treat amniotic fluid embolism?

The condition is difficult to identify and diagnose, but it's important to catch it quickly to prevent life-threatening complications.

The treatment for amniotic fluid embolism may include CPR, oxygen administration or ventilation, blood transfusions, and emergency delivery via C-section.

What percentage of people live after getting an amniotic fluid embolism?

Amniotic fluid embolism is rare, but it is still considered one of the leading direct causes of maternal death.

More research is needed to figure out the exact percentages for survival and mortality rates, but the most recent estimates are that around 60% of people with amniotic fluid embolism survive.

Quick treatment is essential for increasing the chances of survival. According to one study, in around 50% of cases, fatalities occur within one hour after initial symptoms begin.

A Word From Verywell

Amniotic fluid embolism happens unexpectedly and cannot be prevented. Experts still do not know why some people develop it and others do not.

It's important to bring up your concerns and questions about pregnancy complications with your OB-GYN, primary care doctor, or other healthcare professional—particularly if you are worried that you have risk factors for amniotic fluid embolism.

Your healthcare team will go over all your options and monitor you closely throughout pregnancy, labor, and childbirth.

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11 Sources
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